By TKG’s JP Strapp
Reed Abelson recently published a piece in the New York Times that highlighted the trend in health insurance: health maintenance organizations (HMOs) are making a comeback. New types of systems and plans, Abelson writes, operate in a similar way to HMOs, through limiting coverage to a specific narrow network and making it more expensive to see an outside provider.
I disagree with Abelson’s premise that these “HMOs” are the same as the HMOs of the 90s. While the old HMO model was known for its limited coverage and the “gatekeeper” PCP, new “HMO-like” models of care incorporate numerous successful elements of patient care, including actionable data, team-based care, and patient engagement techniques. Models like BCBS Illinois and Advocate’s BlueCare Direct collaboration offer significantly more than traditional managed care; they offer patient-centered care coordination that encourages patients to be activated in their own care, leading to higher patient satisfaction, improved medication adherence, and better health outcomes. With actionable data, providers are given the tools to understand the best means of caring for patients with chronic conditions. Through the use of care coordinators – including case managers and quality navigators – patients are better able to understand why they are receiving treatment and how best to manage their condition. These new “HMO-like” models of care, described by Abelson, are much more than a narrow network; they represent a new type of care delivery.
However, the trend within these new models that is disturbing is the lack of choice for consumers. While the new HMO isn’t a terrible option, what is problematic is that these plans are increasingly becoming the sole option for consumers in a narrowing network. Michelle Andrews published a piece last year for Kaiser Health News that reported on how most health plans in the New York state marketplace generally lack coverage for any out-of-network care. While Andrews writes that this was an unusual situation in early 2015, we are increasingly seeing this increased use of narrow networks in major markets. This trend runs counter to the theme of patient empowerment as a vehicle to meet the Triple Aim and can ultimately disengage the health care consumer.